When Lifelink opened its doors in 1895 in Bensenville, Illinois, the surrounding immigrant community was constantly challenged by unemployment. They shared the same concerns we have today in such circumstances: If we are unable to find work, who will care for our children? Who will care for our aging parents?

Lifelink, known then as the German Evangelical Orphanage and Old People's Home, was indeed a place where these families could find a haven if they needed one. Our doors opened to house nine children and two elderly residents. Since then, we have expanded our programs to meet the needs of many generations. Today, Lifelink serves more than 25,000 children, families, and aging adults annually with holistic faith-based programs designed to serve a multitude of needs.

When we provide these services, we must adhere to the utmost sense of ethical integrity. That commitment certainly can be found in our mission: "In the spirit of Christian love, to assist people of all generations to build and maintain individual well-being and community life by providing services that promote spiritual, physical, social, and emotional health." And this dedication to ethical integrity can be found in our three faith-based values: care, concern, and compassion. We strive to uphold our mission and values when serving individuals in our current programs and developing new programs.

Ethical issues have always been an inherent concern of the social service community. Many organizations similar to Lifelink have worked with ethical issues since their inceptions. Although committees may not have been officially formed, I'm certain that workers have dealt with ethical concerns at ad hoc meetings or even in staff lounges. Although such services are being provided with more sophistication today, Lifelink is still addressing the same basic needs of children, families, and the aging. Ways of meeting those needs, however, are much more complex and are complicated by the laws, rules, and regulations of governments as well as societal and cultural values. To ensure that ethical values are practiced as the norm in all of our programs and to address the complexities of ethical issues, Lifelink established formal ethics committees for our many services several years ago.

The child and family services division at Lifelink has its own ethics committee to monitor potential ethical concerns and to serve as a brainstorming group of knowledgeable individuals who can work with each other to solve ethical dilemmas. It has become more important than ever to establish formal ethics committees as child welfare agencies encounter ethical issues that often challenge received understandings and evoke conflicting moral values.

"Competing values are at the heart of ethical dilemmas," said Cleo Terry, Lifelink vice president of child and family services. "Sometimes it becomes difficult for the social worker who is torn between competing values to juggle working in the best interest of the child and maintaining honor and respect for the client, while at the same time trying to decide whose interest comes first and what's more important."

Lifelink's child and family services division encompasses a variety of programs including: international and special-needs adoption, behavioral health services for substance abuse and domestic violence treatment and family counseling, Latino family services providing culturally competent programs to the Latino community, foster care, Head Start, residential treatment programs for youth, and services to parenting adolescents and homeless youth. The nature of these programs raises a smorgasbord of issues that confront staff. A recent adoption case demonstrates some of the ethical dilemmas we face.

Adoption Case
Mr. and Mrs. G (fictitious initials) applied to adopt a child through one of Lifelink's international adoption programs. Mrs. G was diagnosed with stage one breast cancer 101¤2 years previous to the application for adoption. Her cancer was in remission, and she was doing well. The adoption program requires a five-year remission period. Mrs. G met this requirement with no problems.

After waiting for a short time, Mr. and Mrs. G received a referral for a baby boy. Their paperwork was already processed, and their son was to arrive in one to two months, when Mrs. G called to tell us the sad news that her cancer had returned. She told us that she was now in stage four of breast cancer. The medical team had also discovered that the cancer had traveled to her bones. Even though the G family wanted a son very much and still wanted to go through with the adoption, they felt a moral obligation to inform us of Mrs. G's condition. We appreciated their honesty even though it would jeopardize their chances for adoption.

The social worker for the Gs felt that they were a strong family and had a lot of family support, and that Mr. G could become a very capable single parent if Mrs. G didn't live. Lifelink's international adoption staff knew that the foreign agency would want to know the details about Mrs. G's condition and would most likely ask Lifelink to refer this child to another family. The foreign agency's policy does not allow them to place children with single parents.

This case was brought to the ethics committee, who struggled with the following issues:

• Lifelink's responsibility to inform our foreign agency of Mrs. G's condition.
• Lifelink's concern for the emotional and spiritual impact on a child of placement with a family in which the adoptive mother is terminally ill when the child has already experienced the loss of a birth mother and a foster mother.
• The rights and best interest of the child.
• Mrs. G's right to parent a child under the circumstances.
• Finding another agency that might place a child with the G family under their circumstances.
• The likelihood that Lifelink would be "playing God" if we passed judgment and told the Gs they should not adopt a child.

Regarding the central question, the committee decided that our agency had an ethical responsibility to inform the foreign agency of Mrs. G's condition. Subsequently, as we had expected, the agency withdrew the referral to the G family.

Anticipating that the referral would be withdrawn, the committee also considered whether our agency had a further responsibility to the G family. Reflection on Lifelink's faith-based value of concern led the committee to the conclusion that Lifelink's care for the family should be expressed in an offer of ongoing assistance. Acting in a spirit of Christian love meant that, beyond fulfilling our obligations to the foreign agency and to the family concerning this specific referral, we could continue to show concern by "walking with" the family if they still sought to adopt. We could help them find another adoption source, one willing to refer a child to a family in the Gs' situation or to single-parent families.

But what about our concern for the welfare of the adoptive child whose placement with the Gs might result in the loss of an adoptive mother? Our consideration of the emotional and spiritual impact on the child also reflected a faith-based sensitivity to the child as a whole person. Our staff's positive assessment of Mr. G's capacity to function as a single parent, coupled with the independent assessment of another agency if one proved willing to place a child in this family situation, were countervailing factors.

But they were not the only ones the committee considered. Though sensitive to the powerful impact of loss on children, the committee also took into account the healing power of human love as a reflection of God's love, plus the resilience of the human spirit—even in the face of loss of a parent.

Guided by these considerations, the committee recommended that Lifelink staff help the G family find another source willing to consider the family for placement. If, knowing Mrs. G's health condition and uncertain prognosis, another source decided to refer a child to the family for placement, the committee recommended that Lifelink support the family throughout the adoption process.

Acting on the ethics committee's recommendation, our adoption services staff helped the family find a new source open to the reality of Mrs. G's illness. This organization frequently placed children with single parents and was comfortable placing a child with the G family. The family subsequently received a child. Mrs. G died when the child was 21¤2 years old.

More Examples
Our other programs also have their share of ethical dilemmas. Should Lifelink's sliding scale fee for the economically disadvantaged in our behavioral health programs be available to a client who battered his wife or to someone charged with driving under the influence? Shouldn't the guilty parties carry the full responsibility, including the financial cost, for their actions? Or is assuring that they receive the needed service the best way to protect their victims?

Regardless of the permanency expectations, it is not easy to place a child in a foster family who resides in a high-risk neighborhood in poor housing and has a marginal income. Our decisions to make these placements are challenged by performance contracting, an annual contractual obligation to reunite a certain percentage of foster children with their birth families or place them in adoption.

There are no clear-cut answers to such challenges. Thus, as an organization, we need to be conscious of our corporate values of care, concern, and compassion and to act in "the spirit of Christian love" as stated in our mission. Living up to the corporate mission and values while complying with the guidelines and mandates of governments will always be a way of life for not-for-profit faith-based organizations. The bottom line is that both corporate and government institutions have high standards and are accountable to each other to provide the best care for their clients. With sensitive and formalized deliberations, this relationship can be a successful marriage.